Estimating cost savings from regionalizing cardiac procedures using hospital discharge data

<p>Abstract</p> <p>Background</p> <p>We examined whether higher procedure volumes for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions (PCI) were associated with lower costs per patient, and if so, estimated the financial savings from regionalizing cardiac procedures.</p> <p>Methods</p> <p>Cost regressions with hospital-specific dummy variables measured within-hospital cost reductions associated with increasing hospital volume. We used the regression estimates to predict the change in total costs that would result from moving patients in low-volume hospitals to higher volume facilities.</p> <p>Results</p> <p>A 10% increase in PCI procedure volume lowered costs per patient by 0.7%. For the average hospital performing CABG in 2000, a 10% increase in volume was associated with a 2.8% reduction in average costs. Despite these lower costs, the predicted savings from regionalizing all PCI procedures in the sample from lower to high-volume hospitals amounted to only 1.1% of the entire costs of performing PCI procedures for the sample in 2000. Similarly, the cost savings for CABG were estimated to be only 3.5%.</p> <p>Conclusion</p> <p>Higher volumes were associated with lower costs per procedure. However, the total potential savings from regionalizing cardiac procedures is relatively minor, and may not justify the risks of reducing access to needed services.</p

Non-Abelian Anomalies and Effective Actions for a Homogeneous Space G/HG/H

We consider the problem of constructing the fully gauged effective action in $2n$-dimensional space-time for Nambu-Goldstone bosons valued in a homogeneous space $G/H$, with the requirement that the action be a solution of the anomalous Ward identity and be invariant under the gauge transformations of $H$. We show that this can be done whenever the homotopy group $\pi_{2n}(G/H)$ is trivial, $G/H$ is reductive and $H$ is embedded in $G$ so as to be anomaly free, in particular if $H$ is an anomaly safe group. We construct the necessary generalization of the Bardeen counterterm and give explicit forms for the anomaly and the effective action. When $G/H$ is a symmetric space the counterterm and the anomaly decompose into a parity even and a parity odd part. In this case, for the parity even part of the action, one does not need the anomaly free embedding of $H$.Comment: revise

How citation boosts promote scientific paradigm shifts and Nobel Prizes

Nobel Prizes are commonly seen to be among the most prestigious achievements of our times. Based on mining several million citations, we quantitatively analyze the processes driving paradigm shifts in science. We find that groundbreaking discoveries of Nobel Prize Laureates and other famous scientists are not only acknowledged by many citations of their landmark papers. Surprisingly, they also boost the citation rates of their previous publications. Given that innovations must outcompete the rich-gets-richer effect for scientific citations, it turns out that they can make their way only through citation cascades. A quantitative analysis reveals how and why they happen. Science appears to behave like a self-organized critical system, in which citation cascades of all sizes occur, from continuous scientific progress all the way up to scientific revolutions, which change the way we see our world. Measuring the "boosting effect" of landmark papers, our analysis reveals how new ideas and new players can make their way and finally triumph in a world dominated by established paradigms. The underlying "boost factor" is also useful to discover scientific breakthroughs and talents much earlier than through classical citation analysis, which by now has become a widespread method to measure scientific excellence, influencing scientific careers and the distribution of research funds. Our findings reveal patterns of collective social behavior, which are also interesting from an attention economics perspective. Understanding the origin of scientific authority may therefore ultimately help to explain, how social influence comes about and why the value of goods depends so strongly on the attention they attract.Comment: 6 pages, 6 figure

Long-Term Profile Variability in Active Galactic Nuclei with Double-Peaked Balmer Emission Lines

An increasing number of Active Galactic Nuclei (AGNs) exhibit broad, double-peaked Balmer emission lines,which represent some of the best evidence for the existence of relatively large-scale accretion disks in AGNs. A set of 20 double-peaked emitters have been monitored for nearly a decade in order to observe long-term variations in the profiles of the double-peaked Balmer lines. Variations generally occur on timescales of years, and are attributed to physical changes in the accretion disk. Here we characterize the variability of a subset of seven double-peaked emitters in a model independent way. We find that variability is caused primarily by the presence of one or more discrete "lumps" of excess emission; over a timescale of a year (and sometimes less) these lumps change in amplitude and shape, but the projected velocity of these lumps changes over much longer timescales (several years). We also find that all of the objects exhibit red peaks that are stronger than the blue peak at some epochs and/or blueshifts in the overall profile, contrary to the expectations for a simple, circular accretion disk model, thus emphasizing the need for asymmetries in the accretion disk. Comparisons with two simple models, an elliptical accretion disk and a circular disk with a spiral arm, are unable to reproduce all aspects of the observed variability, although both account for some of the observed behaviors. Three of the seven objects have robust estimates of the black hole masses. For these objects the observed variability timescale is consistent with the expected precession timescale for a spiral arm, but incompatible with that of an elliptical accretion disk. We suggest that with the simple modification of allowing the spiral arm to be fragmented, many of the observed variability patterns could be reproduced.Comment: 74 pages, 4 tables, 35 figure

HarvardX and MITx: Two Years of Open Online Courses Fall 2012-Summer 2014

What happens when well-known universities offer online courses, assessments, and certificates of completion for free? Early descriptions of Massive Open Online Courses (MOOCs) have emphasized large enrollments, low certification rates, and highly educated registrants. We use data from two years and 68 open online courses offered by Harvard University (via HarvardX) and MIT (via MITx) to broaden the scope of answers to this question. We describe trends over this two-year span, depict participant intent using comprehensive survey instruments, and chart course participation pathways using network analysis. We find that overall participation in our MOOCs remains substantial and that the average growth has been steady. We explore how diverse audiences — including explorers, teachers-as-learners, and residential students — provide opportunities to advance the principles on which HarvardX and MITx were founded: access, research, and residential education

Effect of CGRP and sumatriptan on the BOLD response in visual cortex

To test the hypothesis that calcitonin gene-related peptide (CGRP) modulates brain activity, we investigated the effect of intravenous CGRP on brain activity in response to a visual stimulus. In addition, we examined if possible alteration in brain activity was reversed by the anti-migraine drug sumatriptan. Eighteen healthy volunteers were randomly allocated to receive CGRP infusion (1.5 μg/min for 20 min) or placebo. In vivo activity in the visual cortex was recorded before, during and after infusion and after 6 mg subcutaneous sumatriptan by functional magnetic resonance imaging (3 T). 77% of the participants reported headache after CGRP. We found no changes in brain activity after CGRP (P = 0.12) or after placebo (P = 0.41). Sumatriptan did not affect brain activity after CGRP (P = 0.71) or after placebo (P = 0.98). Systemic CGRP or sumatriptan has no direct effects on the BOLD activity in visual cortex. This suggests that in healthy volunteers both CGRP and sumatriptan may exert their actions outside of the blood–brain barrier

Маркетинг отношений в сфере услуг

Цель данной статьи – обосновать необходимость и важность персонифицированного подхода, построение доверительных отношений с клиентами на рынке услуг

Frequency and Practice-Level Variation in Inappropriate Aspirin Use for the Primary Prevention of Cardiovascular Disease Insights From the National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence Registry

AbstractBackgroundAmong patients without cardiovascular disease (CVD) and low 10-year CVD risk, the risks of gastrointestinal bleeding and hemorrhagic strokes associated with aspirin use outweigh any potential atheroprotective benefit. According to the guidelines on primary prevention of CVD, aspirin use is considered appropriate only in patients with 10-year CVD risk ≥6% and inappropriate in patients with 10-year CVD risk <6%.ObjectivesThe goal of this study was to examine the frequency and practice-level variation in inappropriate aspirin use for primary prevention in a large U.S. nationwide registry.MethodsWithin the National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence registry, we assessed 68,808 unique patients receiving aspirin for primary prevention from 119 U.S. practices. The frequency of inappropriate aspirin use was determined for primary prevention (aspirin use in those with 10-year CVD risk <6%). Using hierarchical regression models, the extent of practice-level variation using the median rate ratio (MRR) was assessed.ResultsInappropriate aspirin use frequency was 11.6% (7,972 of 68,808) in the overall cohort. There was significant practice-level variation in inappropriate use (range 0% to 71.8%; median 10.1%; interquartile range 6.4%) for practices; adjusted MRR was 1.63 (95% confidence interval [CI]: 1.47 to 1.77). Results remained consistent after excluding 21,052 women age ≥65 years (inappropriate aspirin use 15.2%; median practice-level inappropriate aspirin use 13.8%; interquartile range 8.2%; adjusted MRR 1.61 [95% CI: 1.46 to 1.75]) and after excluding patients with diabetes (inappropriate aspirin use 13.9%; median practice-level inappropriate aspirin use 12.4%; interquartile range 7.6%; adjusted MRR 1.55 [95% CI: 1.41 to 1.67]).ConclusionsMore than 1 in 10 patients in this national registry were receiving inappropriate aspirin therapy for primary prevention, with significant practice-level variations. Our findings suggest that there are important opportunities to improve evidence-based aspirin use for the primary prevention of CVD